[Dysphagia] NY Times article

[pressmah at sjhmc.org (Pressman, Hilda)]

Just got a consult this AM on a patient who had early stage altzheimer's
then had a hypotensive event at home, CPR in the field and now has anoxic
encephalopathy.  Unresponsive x2 weeks.  They are planning PEG.  Pt. is
pooling secretions in the pharynx.  I pointed out the risk of repeated
episodes of pneumonia.  My recommendation was Hospice consult to assess
removal of NGT  Hilda Pressman

-----Original Message-----
From: Brenda Logsdon [mailto:bklslp@earthlink.net]
Sent: Saturday, May 22, 2004 11:02 AM
To: dysphagia
Subject: [Dysphagia] NY Times article


There are some really good teaching examples in this article.  I think as
Dysphagia therapists, it is really our duty to get in there and talk to
family members about the "what ifs" and help them with their choices.  Ask
them,

If your mom could not eat because she had cancer, would you want this
feeding tube?  Think of late stage Alzheimer's as equivalent to late stage
cancer.  If she had renal failure in this condition, would you start her on
dialysis?  Think of Alzheimer's as late stage brain failure.  If her
cardiopulmonary system could no longer support her life, would that be an
"acceptable" way to go?  Think of this as her gastrointestinal system can no
longer support her life.  

Maybe she is in a terminal state now, we don't really know.  With the
feeding tube, we might be able to keep her alive longer for the next stage
of the disease.  Describe the next stage.  When people with Alzheimer's have
increasing dysphagia or really decrease their intake, there is usually a
reason.  Not eating is a protective measure of the body to increase comfort.
A feeding tube negates that effort.

Many late stage Alzheimer's patients who get feeding tubes only live for a
few more months.  How would you like her to spend those months?  With a
feeding tube, she is still at risk for GI upset, diarrhea, nausea, vomiting,
aspiration, pneumonia, and skin breakdown.  

Some people will still say "yes, we need to try this," and some will say,
"No, that is not what I want."  You tell them, "OK, we will do what we can
to deal with whatever comes next."  Counseling is so hard sometimes.  I
always try to talk to people very early on, when it is not even a
consideration, because it is too hard to make a decision when it has to be
made NOW.  

Brenda Logsdon CCC/SLP
http://home.earthlink.net/~bklslp/index.html
CE Instructor for Dynamic Online
www.dynamic-online.com
"First seek to understand, then to be understood"
bklslp@earthlink.net
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